Anatomy of Upper GI Tract Lab

Workbook
Dr Anthony Adefolaju Monday 28th November 2022
Lecturer in Medical Sc. (Anatomy)
GAdefolaju@uclan.ac.uk Tuesday 29th November 2022
 Learning Outcomes

Describe the functional anatomy of the digestive tract (oral cavity,

oesophagus, stomach, duodenum, jejunum, ileum, caecum and colon),
M1.I.GAS.ANA1 accessory digestive organs (salivary glands, liver, gallbladder, pancreas) and
the spleen.

Outline the major structures of the neurovascular supply to the

M1.I.GAS.ANA2 gastrointestinal system .

Describe the organisation and clinical significance of the parietal and

M1.I.GAS.ANA3 visceral peritoneum, the greater and lesser sacs, mesenteries and
peritoneal ‘ligaments’.
Understand specific common clinical examples associated with the
M1.I.GAS.ANA4 gastrointestinal system.
 THIS SESSION

1. Describe the anatomical arrangement of foregut structures.

2. Relate the anatomy and histology of foregut structures to their

functions.

3. Review the vascular arrangement of the abdomen, with

reference to the coeliac trunk.
Activities Pre-Lab
• General organisation of the digestive tube

• Surface Anatomy

• Peritoneal cavity
 Pre-Lab – General organisation of the digestive tube

C
D
E
F
G

Identify A to I 5
Pre-Lab – General organisation of the digestive tube
Identify A to I
A. Mucosa
B. Submucosa
C. Submucosa plexus
D. Muscularis externa
E. Inner circular muscle layer
F. Myenteric nerve plexus
G. Outer longitudinal ms. Layer
H. Serosa/Adventitia.
I. Mesentery

6
 Pre-Lab: Surface Anatomy
No Description
Transpyloric plane

Xiphoid process

T12 - Aortic opening in diaphragm

Left fifth intercostal space - Apex of heart

Upper margin of liver and Dome of diaphragm and

Vena caval foramen in diaphragm

Fundus of gall bladder,

Head of pancreas and level of second lumbar vertebra

Hilum of left kidney

Hilum of right kidney

A. Match the numbered landmarks to the Oesophageal opening in diaphragm (Which vert level is
this?) 7
descriptions:
 Pre-Lab: Surface Anatomy
No Description
10. Transpyloric plane

11. Xiphoid process

1. T12 - Aortic opening in diaphragm

2. Left fifth intercostal space - Apex of heart

3. Upper margin of liver and Dome of diaphragm and

4. Vena caval foramen in diaphragm

5. Fundus of gall bladder,

6. Head of pancreas and level of second lumbar vertebra

7. Hilum of left kidney

8. Hilum of right kidney

9. Oesophageal opening in diaphragm (Which vert level is
A. Match the numbered landmarks to the
this?) 8
descriptions:
Surface Anatomy

9
Pre-Lab: Peritoneal cavity – Gross Anatomy
Identify the structures labelled 2 - X:

1 Left lobe of the liver

2
3
4
5
6
7 Sigmoid colon
8 Urinary bladder
X

10
 Pre-Lab: Peritoneal cavity – Gross Anatomy
Identify the structures labelled 2 - X:

1 Left lobe of the liver

3 1
5 2
2 Greater curvature of the
x stomach
2 2 2
3 Falciform ligament
4 4
x x 4 Greater omentum
5 Stomach
6
6 Coils of small bowel
7 Sigmoid colon
7
8 8 Urinary bladder
X Parietal peritoneum (cut)

11
 TODAY’S LAB

• 30 minutes of group • 40 minutes of group • 30 minutes of group

work work work

• 10 minutes of • 20 minutes of • 10 minutes of

summary summary summary

Macro & Micro

Virtual Dissection Radiology
Anatomy

Break:- 10 minutes
Activities Workshop 1
• Virtual dissection
 VIRTUAL DISSECTION

• Open the Anatomage app.

• Select the female full body (Asian)

14
 VIRTUAL DISSECTION

A. Identify upper GI organs/viscera in the following

planes:
• Axial (Transpyloric) plane
• Sagittal plane

15
VIRTUAL DISSECTION – Axial plane

16
VIRTUAL DISSECTION – Sagittal plane

17
 VIRTUAL DISSECTION – Freehand sculpt

B. Using the freehand sculpt, dissect the anterior

abdominal wall to reveal the abdominal cavity.

• Identify the distal oesophagus, stomach, duodenum,

pancreas, liver, gall bladder and spleen

18
How to Make a Freehand Sculpt

Step 1: Single tap the

dissection tool icon,
the icon will expand to
display the following
icons,

as well as “Undo” and

“Redo” buttons

Step 2: Single tap the

freehand sculpt tool

19
How to Make a Freehand Sculpt

Step 3: Drag a single finger to

draw a circular (or closed
shape, e.g., square, polygon,
etc. profile) over the desired
location on the cadaver

Step 4: Single tap inside or

outside the profile to dissect
the inside or outside of the
profile respectively. For this
example, the inside has been
selected.

To Undo or Redo a dissection,

tap the “Undo” or “Redo”
buttons respectively. To
completely undo the
dissection, single tap the
dissection restore button
20
Activities Workshop 2
• Oesophagus
• Stomach
• Pancreas and duodenum
• Liver and Gall bladder
 Oesophagus
A. A. Watch the short video of a
B.
bolus passing through the
oesophagus.

B. Follow the oesophagus along its

course and make a note of where
it may be constricted by
neighbouring structures

22
 Oesophagus
A. A. Watch the short video of a
B.
bolus passing through the
oesophagus.

B. Follow the oesophagus along its

course and make a note of where
it may be constricted by
neighbouring structures

‘ABCD‘:
Arch of aorta
Bronchus (left main stem)
Cricoid cartilage
Diaphragmatic hiatus

23
 Oesophagus - Histology
Click this virtual slide
Oesophagus histology
virtual slide

Illustrate the following

on this micrograph
1. Epithelium
2. Lamina propria
3. Submucosal glands
4. Muscularis
5. Myenteric nerve
plexus

How will you classify 1?

24
State the function of 3
 Oesophagus - Histology
Click this virtual slide
Oesophagus histology virtu
al slide 2

Illustrate the following on this

1 3
micrograph
1. Epithelium 2 3
2. Lamina propria
3. Submucosal glands 3
4. Muscularis externa
5. Myenteric nerve plexus 4 5
5
How will you classify 1?
• Stratified squamous epith
5 4
State the function of 3
• Produce mucous
secretions to lubricate the 25
oesophagus
 Stomach
Identify the parts labelled 1 - 5:
1
2

1 5
2 4
3
3
4
5

What’s the functional 4

significance of 2?

Peptic ulcers!
Which of the muscle
layers form 5? 26
 Stomach
Identify the parts labelled 1 - 5:
1
2
1. Distal oesophagus
2. Cardiac notch 5
4
3. Innermost oblique ms.
4. Middle circular ms. layer
5. Pyloric sphincter
3

What’s the functional significance

of 2?
4
The angle contributes to
preventing the reflux of gastric
contents
Which of the muscle layers form Peptic ulcers!
5?
4 27
 Stomach - Histology
Click this virtual slide
Stomach histology virtual sl
ide

Illustrate the following on

this micrograph
1. Mucous neck cells
2. Gastric glands
3. Muscularis mucosa
4. Submucosa
5. Muscularis externa
6. Serosa

Classify Gastric Epithelium.

Name 2 main cell types

found in 2 and their products 28
 Stomach - Histology
Click this virtual slide
Stomach histology virtual slid 1
e

Illustrate the following on this 3 2

micrograph
1. Mucous neck cells 4
2. Gastric glands 4
3. Muscularis mucosa
4. Submucosa
5
5. Muscularis externa
6. Serosa

Classify Gastric Epithelium.

Simple Columnar. 6
Name 2 main cell types found in
2 and their products
• Parietal/Oxyntic cells – HCl
29
• Chief cells - Pepsinogen
 Upper GI Histology
Click this virtual Lumen
slide
virtual slide
Look at the
epithelium in the
micrograph
• From which part
of the gut is this
taken?
• Any clinical
relevance?
• Note: The arrow shows the
direction of movement of gut
content 30
 Upper GI Histology
Note: The arrow shows the direction of
movement of gut content
Click this Lumen
virtual slide
SCE
virtual slide
Look at the
SSE
epithelium in
the micrograph
• From which
part of the
gut is this
taken? At the oesophagogastric junction, stratified
squamous epithelium (SSE) lining the oesophagus
• Clinical is abruptly replaced by simple columnar epithelium
relevance? (SCE) of the stomach
An incompetent inferior oesophageal sphincter may result in chronic
heartburn, from gastroesophageal reflux disease (GERD) >> Barrett’s
oesophagus>>Oesophageal cancer
31
 Pancreas & Duodenum- Relations

Identify the structures labelled 4,5, 9 - 11

1 Gastroesophageal junction
2 Gastroduodenal junction
3 Uncinate process
4
5
6 Sup Mesenteric vessels
7 Common hepatic art
8 Hepatic artery proper
9
10
11
12 Left Kidney
13 Liver (cut)
14 Common bile duct
15 2nd part of Duodenum
16 Splenic vein
The stomach has been removed to expose the dissected
liver, biliary tree, pancreas, duodenum, and superior
mesenteric vessels lying posterior to the stomach bed
32
 Pancreas & Duodenum- Relations
13
1 Identify the structures labelled 4,5, 9 - 11

10 1 Gastroesophageal junction
2 Gastroduodenal junction
14
8 7 9 3 Uncinate process
11 4 Head of Pancreas
2 16 5 Horizontal duodenum
6 6 Sup Mesenteric vessels
4 12 7 Common hepatic art
15 3 8 Hepatic artery proper
9 Body of Pancreas
5 10 Spleen
11 Tail of Pancreas
12 Left Kidney
13 Liver (cut)
14 Common bile duct
15 2nd part of Duodenum
16 Splenic vein
The stomach has been removed to expose the dissected
liver, biliary tree, pancreas, duodenum, and superior
mesenteric vessels lying posterior to the stomach bed
33
 Digestive ducts
Identify the structures labelled 1,2, 8, 10

1
2
3 Uncinate process
4 Duodenojejunal flexure
5 Horizontal duodenum
6
7 Common hepatic art
8
9 Body of Pancreas
10 .

The stomach has been removed to expose the dissected

liver, biliary tree, pancreas, duodenum, and superior
mesenteric vessels lying posterior to the stomach bed
34
 Digestive ducts
10 7
6 1 Identify the structures labelled 1,2, 8, 10

1 Main pancreatic duct

9 2 Common bile duct
3 Uncinate process
2 4 Duodenojejunal flexure
5 Horizontal duodenum
4 6 Cystic duct
7 Common hepatic art
8 Major duodenal ampulla
8 9 Body of Pancreas
10 Common hepatic duct
3 5

The stomach has been removed to expose the dissected

liver, biliary tree, pancreas, duodenum, and superior
mesenteric vessels lying posterior to the stomach bed
35
Gall-stones complications
• Inflammation of the
gallbladder (acute
cholecystitis)

• Jaundice

• Infection of the bile ducts

(acute cholangitis)

• Acute pancreatitis

36
 Pancreas - Histology
Click this virtual slide Identify the structures specified in the box:
Pancreas histology virtual slide
A
Ac- Adipocytes
D
I
Sp septum
A
Name the products
A associated with A.

Name two products

associated with I.

37
 Pancreas - Histology
Click this virtual slide Identify the structures specified in the box:
Pancreas histology virtual slide
A secretory Acini
Ac adipocyte
D interlobular duct
I islet of Langerhans
Sp septum
A
Name the products
A associated with A.
Digestive enzymes
Name two products
associated with I.
Glucagon, Insulin

38
 Liver
Identify the structures labelled 1,2,6,7,9:

1
2 Posterior view of
3 Aorta liver, stomach
4 Duodenum and lesser
5 Lesser omentum omentum. The
6 spleen, left
7 kidney, parts of
the pancreas,
8 Inferior vena cava
aorta and
9 inferior vena
10 Posterior surface of the stomach cava have been
11 Coeliac trunk cut removed.
12 Body of pancreas
X Splenic vein

The Porta Hepatis transmits which of

these structures?

39
 Liver
10 5 Identify the structures labelled 1,2,6,7,9:
2
8 1 Liver
1 2 Caudate lobe
11 3 Aorta
7
9 4 Duodenum
12 x 5 Lesser omentum
6 6 Common bile duct
7 Common hepatic art
8 Inferior vena cava

3 4 9 Portal vein
10 Posterior surface of the stomach
8 11 Coeliac trunk cut
12 Body of pancreas
X Splenic vein

The Porta Hepatis transmits which of

these structures?
Posterior view of liver,
stomach and lesser 6, 7 and 9.
omentum. The spleen,
left kidney, parts of the
pancreas, aorta and
inferior vena cava have
been removed. 40
 Liver - Histology
Click this virtual slide Liver histology virtual slide High magnification Identify the structures specified in the box:
Low magnification A.
B.
C. Capsule
H.
L. lymphatic
PV.
S.
V. Terminal hepatic venule
(central vein)

Which of these form the

portal tract/triad?
Name the cell type found in S.

Function?
41
 Liver - Histology
Click this virtual slide Liver histology virtual slide High magnification Identify the structures specified in the box:
Low magnification A. Hepatic artery branch
B. Bile ductule
C. Capsule
H. hepatocyte plate
L. lymphatic
PV. terminal portal venule
S. Sinusoids
V. Terminal hepatic venule
(central vein)

Which of these form the

portal tract/triad?
Name the cell type found in S. A,B, PV.
Kupffer cells.
Function?
42
phagocytosis
10 minutes
Activities Workshop 3
Blood supply and innervation – foregut
Upper GI Radiology
Coeliac Trunk - branches
Identify the structures labelled A-I

45
Coeliac Trunk - branches
Identify the structures labelled A-I

46
47
 Foregut Innervation
Nerves Nerve roots Target Ganglia
Greater splanchnic 1: Celiac ganglia
nerve

Lesser splanchnic 2: Superior mesenteric

nerve ganglia and
Aorticorenal ganglia

Least splanchnic T12 Renal plexus

nerve

State 1 & 2

In the image, circle the nerves responsible for

sympathetic and parasympathetic innervation to
the oesophagus and stomach.
48
 Foregut Innervation
Nerves Nerve roots Target Ganglia
Greater splanchnic 1: T5–T9 Celiac ganglia
nerve

Lesser splanchnic 2: Superior mesenteric

nerve T10–T11 ganglia and
Aorticorenal ganglia

Least splanchnic T12 Renal plexus

nerve

State 1 & 2

In the image, circle the nerves responsible for

sympathetic and parasympathetic innervation to
the oesophagus and stomach.
49
Review of Innervation

50
 Review: Normal CT

Using the link below, review the radiological anatomy of upper

GI structures and answer the questions in the following slides

Click here

51
 Abdominal viscera – Radiology

2. Aorta
6. Body of vertebra (b)
21 Kidneys (b)
1&33 (a)
17&26. (a)
12 (a)
6
13. (b)
21
5. (a)
25. (b)
35. (b)
57. (b)
50. 1st part of duodenum (b)
Identify the structures specified in the box:
16. Jejunum (d)
What imaging modality is this? 4. Body of pancreas (a)

What plane is this?

52
 Sequential axial CT images, from superior to
inferior Abdominal viscera – Radiology

2. Aorta
6. Body of vertebra (b)
21 Kidneys (b)
1&33 Right lobe of liver (a)
17&26. Left lobe of liver (a)
12 Falciform ligament
6
13. Gall bladder (b)
21
5. Lumen of stomach (a)
25. Stomach wall (b)
35. Pyloric part of stomach
57. Pylorus
50. 1st part of duodenum (b)

Identify the structures specified in the box: 16. Jejunum (d)

4. Body of pancreas (a)

53
Abdominal viscera – Radiology
Identify the structures specified in the box:

6
7
8.
13. Vertebra
20. Right kidney
22.

What imaging modality is this?

What plane is this?

54
Coronal CT image
Abdominal viscera – Radiology
Identify the structures specified in the box:

6. Hepatic vein
7. Liver
8. Stomach
13. Vertebra
20. Right kidney
22. Spleen

55
Gall bladder

 Ultrasound

Play the short video on the bottom left.

Record your observations about the image on

the right.
 Gall stones

 Ultrasound

Play the short video on the bottom left.

Record your observations about the image on
the right.
 Normal
Compare the two images.
Propose a diagnosis for the patient on the right.
 Normal
Splenomegaly

Compare the two images.

Propose a diagnosis for the patient on the right.
 Learning Outcomes

Describe the functional anatomy of the digestive tract (oral cavity,

oesophagus, stomach, duodenum, jejunum, ileum, caecum and colon),
M1.I.GAS.ANA1 accessory digestive organs (salivary glands, liver, gallbladder, pancreas) and
the spleen.

Outline the major structures of the neurovascular supply to the

M1.I.GAS.ANA2 gastrointestinal system .

Describe the organisation and clinical significance of the parietal and

M1.I.GAS.ANA3 visceral peritoneum, the greater and lesser sacs, mesenteries and
peritoneal ‘ligaments’.
Understand specific common clinical examples associated with the
M1.I.GAS.ANA4 gastrointestinal system.